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Factors affecting the morbidity of contact lens-related microbial keratitis : a population study

Association for Research in Vision and Ophthalmology
Publication Date
  • 111300 Optometry And Ophthalmology
  • Contact Lenses
  • Hydrophilic Adverse Effects
  • Corneal Ulcer Epidemiology
  • Eye Infections Epidemiology
  • Adolescent
  • Adult
  • Australia Epidemiology
  • Corneal Ulcer Economics
  • Corneal Ulcer Microbiology
  • Eye Infections Economics
  • Eye Infections Microbiology
  • Female
  • Health Care Costs
  • Hospital Costs
  • Humans
  • Male
  • Middle Aged
  • New Zealand Epidemiology
  • Risk Factors
  • Visual Acuity
  • Mathematics
  • Medicine


PURPOSE: To examine factors influencing the severity of soft contact lens (SCL)-related microbial keratitis.----- METHODS: Cases were detected via surveillance studies in Australia and New Zealand. Factors affecting disease severity (costs, days of symptoms, and 2 or more lines of vision loss) were examined and included age; gender; delay in SCL removal, seeking consultation, or receiving treatment; overnight wear; SCL material (hydrogel or silicone hydrogel [SiH]); and causative organism.----- RESULTS: Two hundred ninety-seven cases were identified: 61% female, age: 35 +/- 13 years (mean +/- SD). Treatment costs were (median [interquartile range]) $760 [1859] and indirect costs were $468 [1810]. Patients were symptomatic for 7 [11] days, and vision loss occurred in 14.3% of cases. Cases with pathogenic causative organisms (66/297, 22%) were 11.4 times (95% confidence interval [CI], 4.2-30.9) more likely to result in vision loss, had longer duration of symptoms (21 [40] vs. 6 [8] days, P < 0.001) and incurred higher costs (5,512 [14,733] vs. 1,048[8,325], P < 0.001). Delays (>12 hours) before treatment increased the likelihood of vision loss (P = 0.048) disease duration (P = 0.004), and associated costs (P = 0.009). Remoteness increased the risk of vision loss (odds ratio [OR] = 5.1; 95% CI 1.6-16.6), and individuals over 28 years of age had longer disease duration (P = 0.02). In overnight wear and after adjustment for culture result and treatment delays, SiH wearers had slightly shorter disease duration (4 [4] vs. 7 [10] days, P = 0.02) but a rate of vision loss and cost similar to those of hydrogel wearers.----- CONCLUSIONS: The causative organism was the major determinant of severity; however, modifiable factors such as delays in treatment had considerable influence. Duration of symptoms was shorter in SiH wearers, but other factors dominated disease outcome in this population study.

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